Ectopic Pregnancy

Question 1

What is an ectopic pregnancy?

Answer 1

Any pregnancy occurring outside the uterine cavity

Question 2

Most common site of ectopic pregnancy?

Answer 2

Fallopian/Uterine tubes

Question 3

Other sites of ectopic pregnancy?

Answer 3

Ovary
Peritoneum
Other organs
C section scar

Question 4

Who gets ectopic pregnancy?

Answer 4

Majority have no predisposing factors but a previous history of ectopic pregnancy, sterilization, PID, subfertility and endometriosis increases risk

Question 5

Mirena and copper coil with ectopic pregnancy?

Answer 5

People with these are very unlikely to get pregnant

-But if they do it has a much higher chance of being an ectopic pregnancy

Question 6

Acute presentation of ectopic pregnancy?

Answer 6

Main symptoms= pain

-May be bleeding but this comes after pain (vice versa with miscarriage)

Question 7

Details about abdominal pain in ectopic pregnancy?

Answer 7

Abdo pain may start on one side of lower abdo but rapidly becomes generalized as blood loss extends into peritoneal cavity

Question 8

Where does blood come from in ectopic pregnancy?

Answer 8

Rupture of pregnancy and leakage into peritoneal cavity
OR
potentially damage to uterine arteries causing haemorrhage

Question 9

What does leakage of blood cause?

Answer 9

Sub-diaphragmatic irritation by blood produces referred shoulder tip pain and syncopal episodes may occur

Question 10

Clinical features of acute ectopic pregnancy?

Answer 10

Shocked women with hypotension
Tachycardia
Signs of peritonism (Including abdominal distension, guarding and rebound tenderness)

Question 11

What is a subacute presentation of ectopic pregnancy?

Answer 11

After a short period of amenorrhoea the patient experiences recurrent attacks of vaginal bleeding and abdo pain

• Breast tenderness
• GI symptoms
• Dizziness or syncope
• Urinary symptoms

Question 12

When should an ectopic pregnancy always be considered?

Answer 12

Any woman who develops lower abdominal pain following an interval of amenorrhoea

Question 13

Investigations for an ectopic pregnancy?

Answer 13

• FBCs
• Beta-HCG
• Blood type matching
• Traditionally laparoscopy was gold standard for diagnosis of ectopic but improvements in transvaginal US mean this is now gold standard

Question 14

What is now seen as gold standard for ectopic pregnancy?

Answer 14

Transvaginal ultrasound

Question 15

Management of mild symptomed ectopic pregnancy?

Answer 15

-Monitoring + safety netting

Question 16

If it a moderate ectopic pregnancy (stable)?

Answer 16

• Woman stable with low Beta-CG and no rupture

- Injection of methotrexate which blocks the enzymes maintaining pregnancy and stops it growing any bigger

Question 17

Management of patient’s with ectopic pregnancy who are acutely unwell?

Answer 17

Surgical management

• Salpingectomy
• Salpingotomy
• If woman is rhesus negative she will be given Anti-D

Question 18

What is salpingectomy?

Answer 18

Removal of tube

Question 19

What is salpingotomy?

Answer 19

Remove pregnancy only

Question 20

Presentation f pregnancy with unknown location?

Answer 20

Amenorrhoeic with abdominal pain

Question 21

Why we think pregnancy of unknown location?

Answer 21

No evidence of pregnancy in uterus, fallopian tube, cervix, C section scar or abdominal cavity but a level of hCG confirming a pregnancy circumstance

Question 22

Consider ectopic pregnancy when?

Answer 22

Any female of reproductive age with amenorrhoea and acute hypotension or an acute abdomen

Question 23

Investigation and treatment of unknown location pregnancy?

Answer 23

Static HCG

Medical: methotrexate